I personally hated the fentanyl patch when I tried it. It made me feel severely under the influence. How do you feel on it and have you tried other options?

Tolerance is going to be an issue with whatever meds you choose. I've found that putting myself through the beginnings of withdrawals a few times a month and aiming for low to mid-level pain, has kept my dosages low for years. I also scale back my break through meds when I feel tolerance starting to creep up on me, and by sufferning through elevated pain levels for 3-4 days, I can avoid escalating my dosages.

The higher the dosages the worse the side effects, so it's always a balancing act.

If you aren't using any break through meds, using a smaller dosage of fentanyl and using break through sparingly as needed, might be worth a try!